title: Prognostic factors affecting survival at recurrence of hepatocellular carcinoma after living-donor liver transplantation: with special reference to neutrophil/lymphocyte ratio.
abstract: BACKGROUND
  In living-donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC), it is important to predict not only who may be susceptible to recurrence but also who may survive longer. The neutrophil/lymphocyte ratio (NLR) is useful to properly assess the patient without decreasing the long-term survival after LDLT. In this study, we investigated the relationship between NLR and prognosis of patients with recurrent HCC after LDLT.
  
  
  METHODS
  In total, 167 LDLTs for HCC were enrolled in this study. Clinicopathologic factors for HCC recurrence after LDLT were investigated and prognostic factors were examined with respect to survival.
  
  
  RESULTS
  The following factors were found to be significant in patients with HCC recurrence compared with the controls: α-fetoprotein ≧300 ng/mL, des-γ-carboxyprothrombin ≧300 mAU/mL, NLR ≧4, tumor number >3, tumor size ≧5 cm, duration of last treatment of HCC to LDLT <3 months, Milan criteria exceeded, histologic tumor number ≧10, histologic tumor size >5 cm, poor differentiation, presence of histologic vascular invasion, adjuvant chemotherapy, and interferon therapy against patients with hepatitis C virus. Male sex, interferon therapy against patients with hepatitis C virus, α-fetoprotein ≧300 ng/mL at recurrence, NLR ≧4 at recurrence, and nonsurgical resection for recurrent HCC were significantly related to poor prognosis. The 3-year survival rate after recurrence was 0% in patients with NLR ≧4 and 43.6% in patients with NLR <4. NLR was reelevated after LDLT in patients who later died; however, NLR gradually decreased in surviving patients.
  
  
  CONCLUSIONS
  NLR at recurrence is a prognostic factor affecting survival after recurrence in LDLT for HCC.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Harimoto
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Nakagawara
authors.forename: Takeo
authors.initials: T
authors.lastname: Toshima
authors.forename: Yo-Ichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ikeda
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000704:Analysis of Variance; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009504:Neutrophils / Q000276:immunology*; D011237:Predictive Value of Tests; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: C097353:AFP protein, human; D000998:Antiviral Agents; D000509:alpha-Fetoproteins; D007372:Interferons